ABSTRACT
The coronavirus disease 2019 (COVID-19) can result in a hyperinflammatory state, leading to acute respiratory distress syndrome (ARDS), myocardial injury, and thrombotic complications, among other sequelae. Statins, which are known to have anti-inflammatory and antithrombotic properties, have been studied in the setting of other viral infections, but their benefit has not been assessed in COVID-19. This is a retrospective analysis of patients admitted with COVID-19 from February 1st through May 12th, 2020 with study period ending on June 11th, 2020. Antecedent statin use was assessed using medication information available in the electronic medical record. We constructed a multivariable logistic regression model to predict the propensity of receiving statins, adjusting for baseline sociodemographic and clinical characteristics, and outpatient medications. The primary endpoint includes in-hospital mortality within 30 days. A total of 2626 patients were admitted during the study period, of whom 951 (36.2%) were antecedent statin users. Among 1296 patients (648 statin users, 648 non-statin users) identified with 1:1 propensity-score matching, statin use is significantly associated with lower odds of the primary endpoint in the propensity-matched cohort (OR 0.47, 95% CI 0.36-0.62, p < 0.001). We conclude that antecedent statin use in patients hospitalized with COVID-19 is associated with lower inpatient mortality.
Subject(s)
COVID-19 Drug Treatment , COVID-19/mortality , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Aged , Female , Hospital Mortality , Hospitalization , Humans , Logistic Models , Male , Middle Aged , New York City/epidemiology , Propensity Score , Retrospective Studies , SARS-CoV-2/isolation & purificationSubject(s)
Blood Coagulation/drug effects , COVID-19 Drug Treatment , Factor Xa Inhibitors/therapeutic use , Factor Xa/metabolism , Heparin/therapeutic use , Partial Thromboplastin Time , Aged , COVID-19/blood , COVID-19/diagnosis , Data Warehousing , Drug Monitoring , Electronic Health Records , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: COVID-19 has spread worldwide and has caused significant morbidity and mortality. Myocardial injury and thrombo-embolism are known complications for those with severe forms of disease. The incidence and risk factors for these complications for those patients who are asymptomatic or with mild forms of COVID-19 is unknown. CASE SUMMARY: In this report we describe the case of a 35-year-old man with no past cardiac history who presented with chest pain and a high-sensitivity troponin level of 386 ng/L in the context of an unspecified mild viral illness 1 month previously. Diagnostic evaluation revealed a new cardiomyopathy, left ventricular thrombus, and mid right coronary artery thrombosis. The coronary thrombosis was treated with thrombectomy. SARS-CoV-2 antibodies returned positive. He initially did well post-procedure; however, prior to discharge, he developed a second arterial thrombo-embolism event, a middle cerebral artery stroke. He was treated with thrombectomy and remains hospitalized. DISCUSSION: Recognition that mild COVID-19 can be complicated by subsequent cardiac injury and/or coagulopathy is important. As more people recover from this viral illness and return to normal activity levels, discussion among cardiac experts has begun regarding screening for occult myocardial injury in those who plan to resume competitive athletic activity. This case highlights the need for investigation regarding (i) the duration of thrombophilia after recovery from illness; (ii) the population that should receive thromboprophylaxis; and (iii) the duration of thromboprophylaxis therapy for COVID-19.
ABSTRACT
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.
Subject(s)
Acute Coronary Syndrome/therapy , Arrhythmias, Cardiac/therapy , Coronavirus Infections/therapy , Heart Failure/therapy , Myocarditis/therapy , Pneumonia, Viral/therapy , Acute Coronary Syndrome/complications , Anti-Bacterial Agents/adverse effects , Antiviral Agents/therapeutic use , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/complications , Azithromycin/adverse effects , Betacoronavirus , COVID-19 , Cardiotonic Agents/therapeutic use , Chronic Disease , Coronavirus Infections/complications , Cytokine Release Syndrome/complications , Cytokine Release Syndrome/therapy , Enzyme Inhibitors/adverse effects , Extracorporeal Membrane Oxygenation , Heart Failure/etiology , Heart-Assist Devices , Humans , Hydroxychloroquine/adverse effects , Intra-Aortic Balloon Pumping , Myocardial Infarction/complications , Myocardial Infarction/therapy , Myocarditis/complications , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral/complications , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , ThromboembolismSubject(s)
Cardiology/education , Cardiopulmonary Resuscitation , Coronavirus Infections/prevention & control , Occupational Diseases/prevention & control , Pandemics/prevention & control , Personnel, Hospital/psychology , Pneumonia, Viral/prevention & control , Advance Directives , Aerosols , Attitude of Health Personnel , Body Fluids/virology , COVID-19 , Cardiopulmonary Resuscitation/ethics , Cardiopulmonary Resuscitation/methods , Chest Wall Oscillation , Coronavirus Infections/complications , Coronavirus Infections/psychology , Coronavirus Infections/transmission , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intubation, Intratracheal/adverse effects , Occupational Diseases/psychology , Occupational Exposure , Patients' Rooms , Pneumonia, Viral/complications , Pneumonia, Viral/psychology , Pneumonia, Viral/transmission , Protective Devices/supply & distribution , Resuscitation Orders , RiskABSTRACT
Novel coronavirus-19 disease (COVID-19) is an escalating, highly infectious global pandemic that is quickly overwhelming healthcare systems. This has implications on standard cardiac care for ST-elevation myocardial infarctions (STEMIs). In the setting of anticipated resource scarcity in the future, we are forced to reconsider fibrinolytic therapy in our management algorithms. We encourage clinicians to maintain a high level of suspicion for STEMI mimics, such as myopericarditis which is a known, not infrequent, complication of COVID-19 disease. Herein, we present a pathway developed by a multidisciplinary panel of stakeholders at NewYork-Presbyterian/Columbia University Irving Medical Center for the management of STEMI in suspected or confirmed COVID-19 patients.